Lewis Eldrin F, Tsang Sui W, Fang James C, Mudge Gilbert H, Jarcho John A, Flavell Carol M, Nohria Anju, Givertz Michael M, Couper Gregory S, Byrne John G, Warner Stevenson Lynne
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Am Coll Cardiol. 2004 Mar 3;43(5):794-802. doi: 10.1016/j.jacc.2003.10.035.
We sought to characterize decisions regarding listing of heart transplant candidates and to determine the impact of delayed listing for a transplant on survival.
Evaluation and listing for heart transplantation have evolved over the past decade, with the complex decision process often extending beyond the time of initial review. Little is known about the current impact of decisions and timing of listing on outcomes.
Decisions were prospectively recorded during the initial committee discussions regarding patients referred for heart transplant evaluation. Survival and transplantation rates were assessed.
A total of 214 patients were evaluated for heart transplantation (age 49 +/- 11 years, ejection fraction 21 +/- 9%, New York Heart Association class III +/- I, peak oxygen consumption 13 +/- 4 ml/kg/min). At the initial evaluation, 44% of patients were deemed eligible, 25% were potentially eligible, 19% were ineligible, and 12% were deferred. For eligible patients, 37% of patients were listed within 10 days of evaluation, and a total of 71% of patients were ever listed. Regardless of transplantation, the three-year survival rate in eligible patients not listed early was similar to that in patients listed immediately (85% vs. 77%, p = 0.34). Ineligible and potentially eligible patients had a higher three-year mortality rate than did eligible patients if transplantation occurred (51% vs. 17%, p < 0.001) or not (57% vs. 19%, p = 0.04).
Using current accepted guidelines, many patients referred for transplant evaluation were not considered eligible for transplantation, and those who were eligible were not often listed immediately. Eligible patients not listed initially did well in the long term, and patients with relative contraindications had worse outcomes with or without a transplant.
我们试图描述关于心脏移植候选者列入名单的决策情况，并确定移植延迟列入名单对生存的影响。
在过去十年中，心脏移植的评估和列入名单的情况有所发展，复杂的决策过程通常会超出初次审查的时间。关于决策和列入名单的时间对结果的当前影响知之甚少。
在初次委员会讨论转诊进行心脏移植评估的患者时，前瞻性地记录决策情况。评估生存和移植率。
共有214例患者接受了心脏移植评估（年龄49±11岁，射血分数21±9%，纽约心脏协会III±I级，峰值耗氧量13±4 ml/kg/min）。在初次评估时，44%的患者被认为符合条件，25%的患者可能符合条件，19%的患者不符合条件，12%的患者被推迟。对于符合条件的患者，37%的患者在评估后10天内被列入名单，共有71%的患者曾被列入名单。无论是否进行移植，早期未列入名单的符合条件患者的三年生存率与立即列入名单的患者相似（85%对77%，p = 0.34）。如果进行移植，不符合条件和可能符合条件的患者的三年死亡率高于符合条件的患者（51%对17%，p < 0.001）；如果未进行移植，情况也是如此（57%对19%，p = 0.04）。
根据目前公认的指南，许多转诊进行移植评估的患者未被认为符合移植条件，而那些符合条件的患者也不常立即被列入名单。最初未列入名单的符合条件患者长期预后良好，有相对禁忌证的患者无论是否进行移植预后都较差。
